title: Diet or diuretic? Treatment of newly diagnosed mild to moderate hypertension in the elderly.
abstract: The aim of this study was to assess the effectivity of dietary measures in the treatment of hypertension. Therefore, a single-blind randomised clinical trial was carried out in elderly persons with recently diagnosed hypertension. Patients were recruited from a general practice (6555 persons) during visits or after written invitation or invitation by phone. New hypertensive patients (with measurements taken on three different occasions >159 mm Hg systolic and/or >94 mm Hg diastolic), aged 60-80 years, without target-organ damage, dementia, diabetes mellitus or malignant disease entered a 3-month intervention programme of either intensive dietary counselling, receiving a sodium-reduced (<100 mmol/24h), potassium-enriched (>75 mmol/24h), and weight-reducing diet (BMI <25), or only 25 mg chlorthalidone a day. Forty-two newly diagnosed hypertensive subjects met the inclusion criteria. Two dropped out from the chlorthalidone group, one with side effects and another after a myocardial infarction. Although blood pressure (BP) in the diet group decreased less than in the drug group, of the patients in the diet group 45% fell back to a normal systolic and 50% to a normal diastolic BP (drug treatment group, systolic 75% and diastolic 85%). In contrast with the diet group, lipid spectrum and blood glucose concentration in the diuretic group, however, deteriorated slightly. The dietary intervention was effective in elderly patients with a systolic or diastolic BP in the range of 160-180 and 95-100 mm Hg, respectively. Reduction in weight should be the primary aim. It is argued that sodium reduction can be achieved better by collective measures. In patients with a BP of more than 180 mm Hg systolic or 100 mm Hg diastolic, dietary advice and drug treatment should be combined.
authors.affiliation: General Practice, Nieuwegein, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Koopman
authors.forename: W
authors.initials: W
authors.lastname: Devillé
authors.forename: J T
authors.initials: JT
authors.lastname: van Eijk
authors.forename: A J
authors.initials: AJ
authors.lastname: Donker
authors.forename: C
authors.initials: C
authors.lastname: Spreeuwenberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000178:diet therapy* / Q000188:drug therapy / Q000378:metabolism; D010349:Patient Compliance; D016037:Single-Blind Method; D015431:Weight Loss
chemical_list: D004232:Diuretics